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Original article Clinical endoscopy| Volume 93, ISSUE 4, P880-887.e1, April 2021

Outcomes of radiofrequency ablation by manual versus self-sizing circumferential balloon catheters for the treatment of dysplastic Barrett’s esophagus: a multicenter comparative cohort study

Published:July 30, 2020DOI:https://doi.org/10.1016/j.gie.2020.07.056
Outcomes of radiofrequency ablation by manual versus self-sizing circumferential balloon catheters for the treatment of dysplastic Barrett’s esophagus: a multicenter comparative cohort study
Previous ArticleProspective development and validation of a volumetric laser endomicroscopy computer algorithm for detection of Barrett’s neoplasia
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      Background and Aims

      Radiofrequency ablation (RFA) is the preferred ablative modality for treating dysplastic Barrett’s esophagus. The recently introduced self-sizing circumferential ablation catheter eliminates the need for a sizing balloon. Although it enhances efficiency, outcomes have not been compared with the previous manual-sizing catheter. We evaluated the comparative safety and efficacy of these 2 ablation systems in a large, multicenter cohort.

      Methods

      Patients undergoing RFA at 3 tertiary care centers from 2005 to 2018 were included. Circumferential RFA was performed in a standard fashion, followed by focal RFA as needed. Outcomes were compared between the self-sizing and manual-sizing groups. The primary outcome was the rate of adverse events, including strictures, perforation, and bleeding. Secondary outcomes were procedure time and treatment efficacy, as assessed by rates and time to complete eradication of dysplasia (CE-D) and intestinal metaplasia (CE-IM).

      Results

      Three hundred eighteen patients were included, 90 (28.3%) treated with the self-sizing catheter and 228 (71.7%) with the manual-sizing catheter. Twenty-one patients (6.6%) developed strictures (8 [8.9%] in the self-sizing group and 13 [5.7%] in the manual-sizing group, P = .32). Of the self-sizing strictures, 75% occurred at the 12J dose before widespread adoption of the current 10J treatment standard. One patient developed bleeding, and no perforations were encountered. Procedure time was significantly shorter in the self-sizing group. No significant differences were observed in rates of and time to CE-D and CE-IM.

      Conclusions

      These findings suggest that both systems are comparable in safety and efficacy. The use of the self-sizing system may enhance the efficiency of RFA for treating dysplastic Barrett’s esophagus.

      Abbreviations:

      BE (Barrett’s esophagus), CE-D (complete eradication of dysplasia), CE-IM (complete eradication of intestinal metaplasia), cRFA (circumferential radiofrequency ablation), RFA (radiofrequency ablation)
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      Article info

      Publication history

      Published online: July 30, 2020
      Accepted: July 26, 2020
      Received: January 9, 2020

      Footnotes

      DISCLOSURE: The following authors disclosed financial relationships: A. Kahn, C. L. Leggett, F.C. Ramirez: Research support from NinePoint Medical. M. B. Wallace: Consultant for Virgo Inc, Cosmo/Aries Pharmaceuticals, Anx Robotica (2019), Covidien, GI Supply, Endokey, Endostart, and Boston Scientific; research support from Fujifilm, Boston Scientific, Olympus, Medtronic, Ninepoint Medical, and Cosmo/Aries Pharmaceuticals; stock or stock options from Virgo Inc; general support from Synergy Pharmaceuticals, Boston Scientific, and Cook Medical. K. K. Wang: Research support from Erbe, EndoRotor, and Fujifilm. P. G. Iyer: Research support from Exact Sciences, C2 Therapeutics, and Intromedic Inc; consultant for Medtronic, Symple Surgical, and CSA Medical. All other authors disclosed no financial relationships.

      If you would like to chat with an author of this article, you may contact Dr Iyer at [email protected]

      Identification

      DOI: https://doi.org/10.1016/j.gie.2020.07.056

      Copyright

      © 2021 by the American Society for Gastrointestinal Endoscopy

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